Outreach Request Form

Event Title

Event Host (organization/department/school)

Event Format/Location (Zoom, Teams, Library Mall, Dejope, etc. Include room number)

Please select an outreach topic:

SUICIDE PREVENTION TRAINING DESCRIPTIONS Recognize, Respond, Refer: Suicide Prevention Workshop: Interactive workshop to practice student mental health support skills and suicide prevention strategies, includes practice scenarios customized for the audience; online training is a pre-requisite [60-90 minutes] | Campus Suicide Prevention & Mental Health Promotion Overview: Presentation about the scope of suicide/mental health concerns among college students, environmental and individual risk/protective factors, upstream prevention approaches, customized discussion about your role/the role of your group in prevention on campus [30-60 minutes] | Campus, Community, and National Mental Health Resources: Only available as an add on to one of the above offerings, includes a more comprehensive overview of mental health and suicide prevention resources (clinical, non-clinical, peer support, lifelines, etc.) [20-30 minutes]

Date of event

Backup date (if applicable)

Event Start Time

:

Event End Time

:

Audience (select all that apply):

Current students
Student Staff (TAs, RAs, House Fellows, etc.)
Faculty
Staff
Prospective students
Families of students
Community members

Estimated number of event attendees

Please arrange to have a sign-up sheet if available. Events must have at least eight attendees in order to have an MHS staff member present.

Contact Person

Contact Office Phone

Contact Cell Number

Contact Email

Is there anything else we should know about the event?